All ETDs from UAB

Advisory Committee Chair

Stephen J O'Connor

Advisory Committee Members

Robert Weech-Maldonado

Nancy Borkowski

Patricia Patrician

Document Type

Dissertation

Date of Award

2016

Degree Name by School

Executive Doctor of Science (DSc) School of Health Professions

Abstract

This study examined the potential relationship between interdepartmental transfers and perceptions of adult patients who were admitted and discharged from a 300-bed, not-for-profit community tertiary hospital in the Midwest. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a publically reported comparative data tool measuring hospital patient experiences. As consumers, patients are more informed about their own health and are challenging the quality and service of care provided by hospitals. The value-based purchasing reimbursement model has become a new challenge for hospitals. Historically, hospitals were reimbursed through a volume driven model. Comparatively, the value-based model focuses on the quality and efficiency of care perceived by the patient. This shift of emphasis for hospitals creates an opportunity to evaluate hospital operations. The Value-Based Theory was utilized as a framework to examine 12 hypotheses regarding patient experiences and interdepartmental hospital transfers. Handoffs and transfers of patient care are daily routines that occur in hospitals. Problems can arise when the responsibility for patient care is transferred from one healthcare professional or groups of professionals to another group during intra-hospital transfer of patients from one unit to another unit (e.g., inpatient unit to radiology; Emergency Department to inpatient unit). The logistic regression models used in this study assessed the relationship between transfers and patient perceptions. The main independent variable of interest was the number of intra-hospital transfers experienced by each subject during their inpatient hospital stay: (1) Transfer0 (no transfers – reference category); (2) Transfer1 (one transfer); (3) Transfer2 (two transfers); and (4) Transfer3 (three or more transfers). The results of the study showed statistically significant relationships between nursing communication, doctor communication, responsiveness to the call button, quietness, cleanliness and recommending the hospital. Further, the control variables had several statistically significant relationships with interdepartmental transfers. This study provides a framework for the application of these findings to be utilized by healthcare executives to determine quality and efficiency strategies. The extant research literature on patient centered care focuses on HCAHPS and the value-based purchasing model. There is paucity, however, in evaluation of hospital operations in delivery of care. Little attention has focused on the effect that intra-hospital handoffs and transfers of care have on the patient experience. This effect is important since value-based purchasing models will result in hospital reimbursements being influenced by measures of patient experiences.

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